Seizures Symptoms and Treatment

Seizures are changes in the brain’s electrical activity. This can cause dramatic, noticeable symptoms or even no symptoms at all. The symptoms of a severe seizure are often widely recognized, including violent shaking and loss of control.

However, mild seizures can also be a sign of a significant medical problem, so recognizing them is important.

Because some seizures can lead to injury or be evidence of an underlying medical condition, it is important to seek treatment if you experience them.

What Are the Types of Seizures?

Several different seizure types exist. One example is non-epileptic seizures, which result from injury. This includes a blow to the head or an illness. When the condition is treated, the seizures go away.

Partial seizures are associated with epilepsy, a condition that causes repeated seizures. This seizure type happens on only one side of the brain.

As a result, one side of the body is affected during a seizure. Other names for partial seizures include focal, Jacksonian, and temporal lobe seizures.

Generalized seizures take place on both sides of the brain. This seizure type affects both sides of the body. This includes the grand mal or tonic-clonic seizure, which is most associated with epilepsy.

Petit mal seizures are another generalized seizure example. Also known as absence seizures, these seizures have few physical symptoms but may involve a person staring off into space for several seconds.

The person’s attention cannot be captured during this time.

Seizure Symptoms

Seizure types — One of the most common seizure types is a convulsion. This may be called a “tonic clonic” or “grand mal” seizure.

In this type of seizure, a person may stiffen and have jerking muscle movements; during the muscle-jerking, the person may bite their tongue, causing bleeding or frothing at the mouth.

Other seizure types are less dramatic. Shaking movements may be isolated to one arm or part of the face.

Alternatively, the person may suddenly stop responding and stare for a few seconds, sometimes with chewing motions or smacking the lips.

Seizures may also cause “sensations” that only the patient feels. As an example, one type of seizure can cause stomach discomfort, fear, or an unpleasant smell.

Such subjective feelings are commonly referred to as auras. A person usually experiences the same symptoms with each seizure aura. Sometimes, a seizure aura can occur before a convulsive seizure.

Seizure triggers — A minority of people have seizure triggers, such as strong emotions, intense exercise, loud music, or flashing lights. When these triggers are at play, they usually immediately precede the seizure.

Although they are more difficult to link to a seizure, other factors can also increase the likelihood that a seizure will happen.

As an example, fever, menstrual periods, a lack of sleep, and stress can all increase the risk of seizures in some people.

After a seizure (postictal state) — For many seizure types, you may be unaware during the seizure. When you are told about your behavior during the seizure, you may not believe it because you have no memory of the event.

The period following a seizure is called the postictal state. During this time, you may be confused and tired, and you may develop a throbbing headache. This period usually lasts several minutes, although it can last for hours or even days.

In some people, the postictal period comes with certain symptoms. For example, you may experience mild to severe weakness in a hand, arm, or leg.

Other people have difficulty speaking or experience temporary (partial) vision loss or other types of sensory loss. These can be important clues about the type of seizure and the part of the brain that was affected during the seizure.

What Causes the Condition?

Seizures can stem from a number of health conditions. Anything that affects the body also may disturb the brain and lead to a seizure. Some examples include:

alcohol withdrawal

bites and/or stings

brain infection, such as meningitis

brain injury during childbirth

brain defect present at birth

choking

drug abuse

drug withdrawals

electrolyte imbalance

electric shock

epilepsy

extremely high blood pressure

fever

head trauma

kidney or liver failure

low blood glucose levels

stroke

Seizures can run in families. Notify your physician if you or anyone in your family has a history of seizures.

In some instances, especially with young children, there may be no known seizure cause.

What Are the Effects of Seizures?

If left untreated, seizures can worsen in terms of symptoms and become progressively longer in duration.

Extremely long seizures can lead to coma or death.

Seizures also can lead to injury, such as falls or trauma to the body if convulsions are involved.

For this reason, it is important for those with epilepsy to wear a medical identification that helps emergency responders identify that person.

A person who experiences seizures also should notify friends and family of how to care for the person while a seizure is occurring.

This includes taking steps to reduce the risk of injury like cushioning your head, loosening tight clothing, and turning you on your side if vomiting occurs.

How Are Seizures Diagnosed?

Physicians can have a difficult time diagnosing seizure types. Your doctor may suggest many tests to accurately diagnose a seizure to ensure treatment recommendations will be effective.

Your doctor will consider your full medical history and the events leading up to the seizure. For example, conditions such as migraine headaches, sleep disorders, and extreme psychological stress can cause seizure-like symptoms.

Lab tests may help to further rule out other conditions that can cause seizure-like activity. These include:

blood testing to check for electrolyte imbalances

spinal tap to rule out infection

toxicology screening to test for drugs, poisons, or toxins

An electroencephalography or EEG test can help a physician diagnose a seizure. These tests measure your brain waves. Viewing brain waves during a seizure can help a physician diagnose the seizure type.

Imaging scans such as a CT scan or MRI scan also can help by providing a clear picture of the brain, allowing your doctor to see any abnormalities like blocked blood flow or a tumor.

How Is the Condition Prevented?

In many instances, a seizure cannot be prevented. However, maintaining a healthy lifestyle can give you the best chance at reducing your risk.

This includes getting plenty of sleep, eating a healthy diet, and exercising regularly.

Engaging in stress-reducing techniques may help to reduce seizures. You also should refrain from taking illegal drugs.

If you are on medication for epilepsy or other medical conditions, be sure to take them as directed to prevent seizures.

Seizure Treatment

The appropriate treatment of your seizure will depend upon what type of seizure you had and whether the seizure was caused by epilepsy or another factor.

As an example, if your seizure was caused by an infection affecting the brain, treatment of the infection should prevent you from having more seizures. Likewise, if your seizure was caused by a psychological problem, such as anxiety, treatment of the psychological problem should remedy the seizures.

Seizure medications — If you have epilepsy or if your seizure was caused by a stroke, tumor, or some type of permanent brain injury, you may to take one or more anti-seizure medications, referred to as antiepileptic drugs (AEDs).

Anti-seizure medications prevent or reduce the number or severity of a person’s seizures.

Healthcare providers may not recommend starting these drugs until you have had at least two seizures, in part to make sure that the first seizure was not an isolated incident.

However, your healthcare provider may recommend an anti-seizure medication after a single seizure if you are at high risk of having a second seizure or if you are at high risk of injury related to the seizure.

Starting anti-seizure medication therapy early reduces the risk of another seizure and is generally safe.

However, many people dislike taking medications every day, and anti-seizure medications can cause side effects and carry certain risks.

Discuss the options for starting an anti-seizure medication with your healthcare provider.

Choosing a seizure medication — In selecting a medication, your healthcare provider will consider your seizure type as well as other medical conditions that you might have and medications you may be taking.

Finding the right anti-seizure medication may require a number of adjustments in medications and dosages.

You will meet regularly with your healthcare provider when you are first trying a new medication, and will start with a low dose and slowly increase it, so that you can find the lowest effective dose.

Only about half of the people with a new diagnosis of epilepsy stop having seizures with the first anti-seizure medication.

That means that most people have to try more than one medication before they find one that works well. The best medication is one that offers the most protection from seizures with the fewest possible side effects.

The good news is that there are many anti-seizure medications to choose from, so the chances are good that you will find one that works without too many side effects.

If you take an anti-seizure medication that causes uncomfortable side effects, such as a skin rash, tell your healthcare provider.

In some cases, side effects will go away once you have been taking the medication for a while. In other cases, your healthcare provider may lower your dose or switch you to another medication that is less likely to cause side effects.

If a single anti-seizure medication is not effective, your provider may suggest combining two anti-seizure medications.

Although this is a sound strategy, combinations of anti-seizure medications are not usually recommended until you have tried at least two anti-seizure medications.

Generic anti-seizure medications — Several anti-seizure medications are available as generic formulations, which can help you to save money on the cost of your prescriptions.

Generic medications should be as effective “as the brand name drug.

However, if your clinician has determined that you need a specific brand or form of medication to control your seizures, be sure that your prescription includes the statement “no interchange” or “no substitution”.

This lets your pharmacist and insurance company know that the generic drug should not be substituted for the brand name drug.

Side effects — Each anti-seizure medication can cause side effects, which can affect each person differently. Anyone taking an anti-seizure medication should be aware of some side-effects. These include the following:

An increased risk of becoming suicidal. If you start to become depressed or have thoughts of harming yourself or others while taking an anti-seizure medication, speak to your healthcare provider right away. (See ‘Psychological and social issues’ below.)

A rare but serious skin disorder called Stevens-Johnson syndrome, which can cause fever and a painful, sometimes blistering, rash that eventually kills the top layer of skin. This side effect is most likely to happen in people taking carbamazepine, oxcarbazepine, phenytoin, and lamotrigine, and it is mostly likely to occur within the first two months of use. If you notice a severe rash while taking an anti-seizure medication, call your healthcare provider right away.

A weakening of the bones (osteoporosis). This can occur after long-term use of anti-seizure medications. There are steps you can take to protect and strengthen your bones. If you are concerned about your bone health, or are at risk for osteoporosis, ask your healthcare provider what you can do to keep your bones as healthy as possible. (See “Patient information: Osteoporosis prevention and treatment (Beyond the Basics)” and “Patient information: Calcium and vitamin D for bone health (Beyond the Basics)” and “Antiepileptic drugs: Mechanism of action, pharmacology, and adverse effects”.)

Seizures that persist despite medication — Although anti-seizure medications work for many people with seizure disorders, some people continue to have seizures even after trying several medications.

For them, other treatments may be an option.

For example, surgery to remove the portion of the brain causing the seizures or severing the connection between the two halves of the brain can reduce or eliminate seizures in some people. (See “Surgical treatment of epilepsy in adults”.)

Others may benefit from treatment with an implanted electrical device such as a vagal nerve stimulator or responsive cortical neurostimulation device.

(See “Vagus nerve stimulation therapy for the treatment of epilepsy” and “Evaluation and management of drug-resistant epilepsy”, section on ‘Cortical stimulation’.)

What’s more, several experimental treatments are in development. If you cannot adequately control your seizures with medication, ask your healthcare provider if any other treatment strategies might be appropriate for you.

Referral to a neurologist who specializes in epilepsy may be indicated if seizures do not come under control with a single medication or if there are questions about the cause of the seizure disorder.

Increasing your chance for success — The things you do can have a big impact on how well your anti-seizure medication works.

Take your medication exactly as directed, at the right times, and at the right doses. Ask your healthcare provider to write down any special instructions.

Ask what side effects you can expect and what to do about them. Even if you develop uncomfortable side effects, don’t stop taking your anti-seizure medication without first speaking to your healthcare provider.
Be careful not to let your prescription run out. Stopping anti-seizure medication abruptly can put you at risk of seizure.

While taking an anti-seizure medication, do not start taking any other medications including over-the-counter medications and herbal supplements without first checking with your healthcare provider. Anti-seizure medication can interact with prescriptions, over-the-counter medications, and herbal supplements, so mixing them can be dangerous.